An adult patient with persistent asthma has been prescribed fluticasone (Flovent) HFA inhaler twice daily. Which instruction should the nurse practitioner emphasize for every use?

Question

Accepted Answer

✅ C. Rinse the mouth with water and spit after each inhalation
Fluticasone is an inhaled corticosteroid (ICS). Local deposition of steroid on the oropharyngeal mucosa suppresses local immunity and predisposes to oral candidiasis (thrush) and dysphonia (hoarse voice). Rinsing the mouth with water and spitting after every actuation — combined with using a spacer when the device is an MDI — substantially reduces oropharyngeal drug deposition and these local adverse effects. This is standard patient teaching for ALL inhaled corticosteroids (fluticasone, budesonide, beclomethasone, mometasone, ciclesonide).

❌ A. Use before exercise as needed for shortness of breath
Fluticasone is a controller medication taken on a scheduled basis — it has no rapid bronchodilator effect. Pre-exercise dosing applies to short-acting beta-agonists (albuterol) given 15–20 minutes before activity, not to ICS.

❌ B. Take on an empty stomach with a full glass of water
This is oral medication guidance and irrelevant to an inhaled corticosteroid, which is delivered directly to the lungs. Fluticasone HFA is actuated and inhaled; no water or fasting is required.

❌ D. Hold the next dose if pulse exceeds 100 beats per minute
Tachycardia is a concern with beta-agonists (albuterol, levalbuterol), not with inhaled corticosteroids. Fluticasone does not produce clinically significant tachycardia at therapeutic doses.

:::pearl
Every ICS (fluticasone, budesonide, mometasone) requires rinse-and-spit after each use to prevent oral thrush and dysphonia — add a spacer with an MDI for even less oropharyngeal deposition.
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Fluticasone

✅ Indications

⚙️ Mechanism of Action

📏 Dosing

🚫 Contraindications

⚠️ Adverse Effects

🔬 Monitoring

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